50 Things New Nurses Need to Know About Calling Doctors and Other Providers
Calling doctors and providers is often a skill that new nurses need to practice often before they feel comfortable. If you want the inside track on how experienced nurses take calls from providers, here are 50 items to consider when making a call.
Few things give a new nurse more stress than having to call a doctor or other provider. Other providers include advanced practice nurses and sometimes physician's assistants. It is far easier to ask a coworker for help or even a manager, but calling a provider is often fraught with feelings bordering on terror for some. Most nurses can remember the first time they called a with an inward shudder. It's part of the job, and you do get used to it after a while.
It also depends on when you call the doctor or provider. If you are calling in the middle of the night, your breath is more likely to hitch than if you are calling on day shift. Even better is having a hospitalist or APRN on call who is usually awake during the nighttime hours, though that isn't possible in every nursing setting. With that background, here are 50 helpful hints for new grads when making calls to doctors and other providers.
Use the SBAR method: situation, background, assessment, and recommendation.
Know the patient's code status.
Always have a set of vital signs and allergies, no matter what you are calling for, including patient weight, especially in pediatrics.
Access the chart and open to the last set of orders that were written. Also know the medications the patient is on, the IVs that are running, and drip rates.
Pull up the latest blood work, most importantly the CBC and BMP.
Know your patient's history in case the provider on call isn't familiar with them.
Get straight to the point, and do not engage in chit chat.
Ask around to other nurses before you call because they may know the answer.
Realize that you are only doing your job and protecting your patient.
Realize the doctor or provider has a duty to the patient, and they need to help you.
Don't take a cranky provider personally. It has nothing to do with you.
Clarify orders specifically before hanging up the phone. Always read back the order, even if they are in a hurry. Most hospitals require "read back" to be documented.
Call doctors or providers with any condition change, no matter how silly it may seem.
Don't let your fear keep you from confronting a doctor or provider.
It is okay to give your opinion on what should be done. Your assessment is just as valid as theirs is.
Take orders from doctors or APRNs, not medical assistants. Also, confirm the credentials and spelling of the provider's name prior to hanging up.
Try to find somewhere quiet to make your call.
Don't wait for the doctor or provider to respond to you. Get your work done while you are waiting.
You may need to interrupt patient care to answer a call, unless it is an emergency.
Everyone's time is precious. Don't make them wait on hold forever and don't stay on hold forever.
If the provider is talking too quietly, don't hesitate to make them speak up.
If they have an accent that throws you, don't be afraid to make them repeat themselves. It is for your patient's safety -- and yours!
If a doctor or provider recommends a questionable course of action, take it to your charge nurse and up the chain of command.
Providers can be wrong, and we are the last check between them and the patient.
Politely excuse yourself from taking care of another patient before answering a call.
Don't run down the hall because a provider is calling.
If a provider's earlier written order is too difficult to read, call for clarification.
Try to develop professional relationships with doctors and providers so calls are not so awkward.
Always be polite, even if they aren't.
Be assertive and firm if you need to, but don't become aggressive.
Always thank them for their time. It is their job, but thanks go a long way.
Don't develop attitudes about certain doctors or providers because of their reputations. Take them as they are at the moment you call them because the rumors may not be true.
If the rumors are true, remember that you are a professional and deserve respect.
Don't let a provider's treatment of you carry through the whole shift, making your work time miserable.
If a doctor or provider is very out of line, document with an incident report, tell the charge nurse, and be sure your nurse manager is aware of their behavior.
Talk to the provider like your equal. You are.
Organize yourself so that you can address all problems at once and avoid multiple phone calls.
Give on call doctors and providers the benefit of the doubt because they are often clueless about someone else's patient.
Don't make nervous jokes on the phone, no matter how charming you may think it is.
Execute orders as quickly as you can and report if that causes problems.
Vent to other nurses if you are upset over how you were treated.
Don't always expect the provider will be hostile. In many situations, they aren't.
If you don't know something, don't be afraid to admit it. Offer to call back with the information.
Don't allow coworkers, patients, or family interrupt you while talking to a provider. Politely ask them to wait a moment until you are done.
Try to talk to doctors and providers on land lines as cell phones can drop calls or make it hard to hear.
If your cell phone is malfunctioning, don't be afraid to ask them to call you back or offer to call them back.
Don't allow a provider to make you take informed consent from a patient. It is their job to inform the patient and yours to witness -- even with blood products.
Always have a clean piece of paper and working pen on hand. Don't put the order directly into the chart or the computer as it may change or be transcribed incorrectly.
If the provider has the capability of sending electronic orders, ask them to do so.
When in doubt, call. Nothing is silly or bothering them if it keeps the patient safe.
Calling doctors and provider is one of those skills that get better with experience. If you are a new nurse, hopefully these tips will help you. If you are an experienced nurse, please share your tips that you've learned over your years in nursing. Put them in the comments so other nurses can benefit.
We've raised it as an issue. Blood gas results automatically print at the nurses station and are available on the EMR in less than 20 minutes time. That's within the window for a critical care nurse to apply judgement on the urgency of the result. There's no reason for a nurse to react in a knee-jerk fashion by calling a provider right away just because a "messenger" from the lab called about a critical result without waiting for the full panel. Now if it's taking forever for the result to show up, I would appreciate a heads up that the results are taking a while.
The one thing I would add to that list is that before you do all that, determine IF you really need to call the MD (or NP, or PA, or whoever...I'll just use MD to cover all of them). Ask yourself if this is something that you/your charge/your manager/someone else can address. Look at the chart to see if there's already parameters for holding/giving a med or for notifying the MD about a status change. Read the MD's most recent progress note to determine if the issue was already addressed: for example, if your patient wants Norco and the MD has already told them "No", the MD isn't going to appreciate you calling to ask if the patient can have Norco.
If it is a matter that does need to be addressed by the MD, also determine if you need to call NOW. If the MD hasn't seen the patient yet today, can it wait until the MD gets up there? Can it wait a couple of hours until sunrise? Can it be addressed via text/e-mail instead of an immediate telephone call?
And last, always remember that just because the patient says you have to drop everything and call the MD because "it's an emergency!" doesn't mean it's actually a bona-fide emergency. Use your nursing judgment and assess the situation.
Some more things from the person getting those calls:
1. Know the team that the patient is on when calling night float. My hospital has 9 inpatient medicine teams (not counting surgery, neurosurgery, ortho, and family medicine). If I know the team, I can more easily find the correct list that the patient is on.
2. If it's a death notification, for the love of all that is good and holy, tell me it's a DNR before telling me the patient died.
3. Is the abnormal lab something that matters? 3 AM calls for a potassium of 3.4?
4. A good way to start off a conversation when calling night float (the other intern and I are covering over 100 patients...), "I'm calling about Mr. So-and-so, IM Team D. This is a XX y/o male with a history of ____ admitted for ____."
5. Know if what you're calling about has been addressed. Getting called because the patient who just was brought up from the ED has a fever of 101 isn't helpful when that patient was admitted for sepsis (yes, real call). Same thing for XX electrolyte issue that was treated 5 hours ago (yes, real call).
Specializes in Gerontology, Med surg, Home Health.
Use the SBAR and know what you want from the provider who is on the other end of the phone. Don't call Nancy NP and tell her Mrs. Jone's BP is 86/50 without telling her that the highest Mrs Jones ever runs is 90/52 and she does well. Let the NP/PA know the capabilities of your facility---and suggest a plan of action: We'll get STAT labs and a STAT xray-should we start an IV?
3. Is the abnormal lab something that matters? 3 AM calls for a potassium of 3.4?
5. Know if what you're calling about has been addressed. Getting called because the patient who just was brought up from the ED has a fever of 101 isn't helpful when that patient was admitted for sepsis (yes, real call). Same thing for XX electrolyte issue that was treated 5 hours ago (yes, real call).
Sounds like somebody, somewhere wrote a notify provider if parameter. We routinely have patients here with notify provider if patient has a temp >100.5.
I've also seen somebody write a parameter of "notify provider of abnormal lab values." Pt.'s nurses had prior difficulties with the resident and proceeded to notify them of ALL abnormal labs. Including glucose 106, K 3.4, Na 133, etc. etc.
Sounds like somebody, somewhere wrote a notify provider if parameter. We routinely have patients here with notify provider if patient has a temp >100.5.
I've also seen somebody write a parameter of "notify provider of abnormal lab values." Pt.'s nurses had prior difficulties with the resident and proceeded to notify them of ALL abnormal labs. Including glucose 106, K 3.4, Na 133, etc. etc.
A new temp of 100.4? By all means, please let us know and no one should be getting any flak over that. A continuing temp of 100.4, especially one admitted 3 hours ago and who is already on broad spectrum antibiotics with a septic workup? Yea, that's pretty much why the patient was admitted in the first place.
Potassium of 3.4, on the other hand, represents something that is often left to ride without other reasons to treat and is often from a lab almost 24 hours old when night float is being called.
Now for the resident who is getting called for every abnormal lab, there's a back story there and I'm willing to take less than even money to bet that the resident probably deserved it for some reason.
This is a great post. Calling a doctor in the middle of the night can probably be intimidating for a new nurse, but if you're genuinely concerned about the patient we want to hear about it. We're all on the same team.
Here's another one to piggyback on the great suggestions made on this thread:
If a family member comes to visit a patient at midnight, and demands to speak to the physician for a status update or some non-urgent concern, please do not hammer-page a busy/swamped intern to come speak to the family member immediately because they are pestering you, as they are usually covering 50 patients and taking admissions in the ED, receiving ICU transfers, screening patients into the ICU, taking part in a rapid response/code situation, hell maybe they magically found 47 seconds to scarf down a banana in a documenter room (joking ).
I truly feel terrible when a family member constantly badgers a busy/overworked RN to page the doc at some ungodly hour, but if they could somehow find a way to make them wait till the morning, it does wonders for us all. The primary team is the best at answering all the families questions. And if the RN text-pages me to inform me about a family member that feels uninformed, I make sure to jot down on my sign out so that I can tell the primary team in the AM to address the families so that the RNs and MDs overnight do not get bothered by this and can instead concentrate on providing optimal patient care instead of other non-clinical duties.
I would add just one more thing, coming from being on the other end of the phone, that I always appreciate:
Ask the other nurses on your floor if anyone else needs to talk to the same provider.
I can't tell you how many times a nurse calls me at midnight wanting a sleep aide ordered and then 10 minutes later I get a call from another nurse on the same floor. :)
And don't be nervous to call we are all on the same team, and if someone is being rude then they do not have the patient's best interest in mind.
That was a really good article but is easier said than done. I have been a nurse for more than 20 years and I am still very anxious when I need to call an MD. Even though I have spoken to more pleasant md's than ones with attitudes it's the ones with attitudes that stand out more in my mind and am having difficult time being able to deal with it.
Sounds like somebody, somewhere wrote a notify provider if parameter. We routinely have patients here with notify provider if patient has a temp >100.5.
I've also seen somebody write a parameter of "notify provider of abnormal lab values." Pt.'s nurses had prior difficulties with the resident and proceeded to notify them of ALL abnormal labs. Including glucose 106, K 3.4, Na 133, etc. etc.
*dies laughing*
The flip side to the notify provider if orders is the "do not page on" order. I don't care who they think they are, if a pts BP is 80s over and they're symptomatic and we're not currently addressing, you're dang skippy I'm calling (provided not EOL, etc.)
Example: had a resident refuses anything but Tylenol for pain relief in my cirrhosis pt, despite the 4-5/10 back ache reported. Put in an order to only check pain levels once a shift. Nope, Doogie, not happening on a few different levels. I usually just ask them to call me and address head on, reduces me playing pager tag with them.
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Corey Narry, MSN, RN, NP
8 Articles; 4,475 Posts
kgoode0919
We've raised it as an issue. Blood gas results automatically print at the nurses station and are available on the EMR in less than 20 minutes time. That's within the window for a critical care nurse to apply judgement on the urgency of the result. There's no reason for a nurse to react in a knee-jerk fashion by calling a provider right away just because a "messenger" from the lab called about a critical result without waiting for the full panel. Now if it's taking forever for the result to show up, I would appreciate a heads up that the results are taking a while.